Inside and outside the Capitol, focus is on Medicaid

Updated 2:08 am, Wednesday, March 6, 2013

AUSTIN — A crowd rallied at the Capitol on Tuesday to pressure Gov. Rick Perry and lawmakers to expand Medicaid while, inside, decisionmakers confronted the political nature of the battle and discussed ways to provide health care coverage to more Texans.

“I think the Obama administration is really looking to help us out. I think they know he (Perry) is not going to capitulate,” said Sen. Bob Deuell, R-Greenville, who has lofted an alternative to Medicaid expansion.

Even if every other state took part, Deuell said, “I'll bet he wouldn't do it. I don't mean that as a criticism.”

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Deuell wrote to Perry last week, suggesting the state ask for a block grant that would allow private insurance assistance for Texans who otherwise would be eligible for coverage under the federal health care law's Medicaid expansion.

The Medicaid expansion targets uninsured low-income adults who aren't part of the traditional Medicaid program.

Advocates estimate that from 2014 to 2023, that would mean an additional $100 billion in federal Medicaid money for Texas, matched with a maximum of $15 billion from the state.

Perry and other Republicans have said they don't want to put more money into Medicaid as it currently exists, saying it's broken.

For uninsured Texans, health care professionals and advocates who arrived at the Capitol rally, it boiled down to this chant: “Perry don't care.”

“All of us are paying more because there are so many people who don't have insurance. We're all paying what's essentially an extra tax. For us to say no to Medicaid expansion is just crazy,” said Dr. Robert Luedecke, an anesthesiologist from Helotes. “The economics are not an issue, it's just the politics.”

Perry has said he would welcome the flexibility that would come with a Medicaid block grant, but it's an idea that state lawmakers acknowledge could be difficult for the federal government to accept. Perry spokeswoman Lucy Nashed said the governor will continue working with lawmakers on a solution.

Federal officials have said block grants are not an option.

The House Republican Caucus on Monday voted against Medicaid expansion under the federal health care law in its current form, but it didn't close the door to covering more people if given federal flexibility.

Deuell's idea is among several that have been floated by lawmakers who aren't ready to embrace expanding Medicaid as it currently exists but are eager to discuss alternative ways to lure the billions of dollars the state would get it if implemented the program.

Republicans have talked about co-pays and deductibles, managed-care expansion and incentives for private-insurance coverage.

Deuell said Tuesday he hadn't received an answer from Perry about his proposal. But he said he has received positive feedback from some people, including Health and Human Services Executive Commissioner Kyle Janek.

He noted, in a bow to the political nature of the fight, “Republican political consultants like the idea.”

Rep. John Zerwas, a Simonton Republican who oversees human services issues on the House Appropriations Committee, said he liked Deuell's idea but suggested it could be “a stretch” for the federal government to negotiate at that level.

Zerwas, Deuell and others, however, have watched with interest the federal government's decision to allow Arkansas to use Medicaid money to buy private health insurance for poor people.

“Some of it may just come in what you call it. 'Block grant' doesn't resonate very well with them,” Zerwas said.

A key selling point, Deuell said, is that he believes it could cover the million-plus people who would be part of the Medicaid expansion, but that the state would offer to do so with just half the money — $50 billion over 10 years, rather than $100 billion.

While much of the legislative debate has emphasized the economic impact of expansion, Tuesday's demonstrators sought to re-focus discussion on the people who would be most effected.

Despite feeling ill for much of last year, LaToya White told the crowd that she put off seeking medical attention because she lacked insurance and struggled already to pay the bills at the Houston-area home she shared with her three children.

Only once the pain became unbearable, she checked into an emergency room last April and received a frightening diagnosis: untreated sickle cell anemia had led to organ failure. She required two blood transfusions before she recovered.

“The doctor told me if I hadn't come in that night, I probably would have died,” she said. “All I kept thinking is, 'I have three children. I have to get insurance somehow or what's going to happen to my children?'”

For Frances Arredondo, the state's tight eligibility requirements led to a seemingly illogical choice. The Pasadena mother said she was kicked off Medicaid rolls last year because the $2,000 a month she earned as a home health care provider put her $50 over the threshold to qualify.

She could either keep working and forgo expensive treatment for her 15-year-old daughter's autoimmune hepatitis and juvenile rheumatoid arthritis or quit with the assurance that the child's health care needs would be met.